Labels: Misc

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Dems hedge on healthcare
By Manu Raju

Congressional Democrats are backing away from healthcare reform promises made by their two presidential candidates, saying that even if their party controls the White House and Congress, sweeping change will be difficult.

It is still seven months before Election Day, but already senior Democrats are maneuvering to lower public expectations on the key policy issue.

In the back of their minds is the damage done to President Bush's second term by his failed attempts to change the nation's Social Security policy.

For some senators, the promises made by Sens. Barack Obama (D-Ill.) and Hillary Rodham Clinton (D-N.Y.) outside of Washington may not match the political reality on Capitol Hill.

"We all know there is not enough money to do all this stuff," said Sen. Jay Rockefeller (D-W.Va.), a Finance Committee member and an Obama supporter, referring to the presidential candidates' healthcare plans. "What they are doing is... laying out their ambitions."

Labels: Insurance, Misc

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Health care is filled with the unintended consequences of laws, regulations and poor planning that plague our ability to care for patients. Here are a few, in no particular order. You may have more to add.

* Lab laws. I used to be able to contract with labs to do tests on my patients. I negotiated a low fee, kept a few dollars for lab draw and my services and everyone won. Enter California Legislature. Now patients have to go to another lab for blood tests. Pap smears cost $55 rather than $7 and a blood panel that was $22 now costs $180. Unintended consequence: Primary care lost a revenue stream, patients get gouged on test costs. (By the way, this law was sponsored by the big laboratories.)

* Employee break legislation. A wonderful new law says all employees (think nurses) must take a lunch break within 5 hours of starting a shift, even if she is taking care of a patient, in the OR, dieting, or just not hungry. To stagger breaks some nurses will be eating lunch at 9:30 AM. Yes, more nurses will be hired to cover breaks. Unintended consequence: Watch health care costs continue to soar.

* Stark Laws. Primary care physicians are not allowed to invest in ambulatory care centers or surgi-centers. It's fine for surgeons, anesthesiologists, gastroenterologists and all others to be part of the out-patient trends for patient care and they are partnering with hospitals and other organizations across the U.S. Unintended consequence: More reasons for demise of Primary Care.

* Discounts Illegal. Medicare and Health insurers have made it illegal for physicians to offer discounts for their share of the co-pay for covered services. I guess they think patients will utilize more service (?) if they don't pay their share. Unintended consequence: Patients pay more even if they need a break.

* New Triplicate Laws. The State and Feds have made it so difficult to prescribe pain medication with special prescription pads and regulations regarding refills that physicians are hamstrung in prescribing the best medication. Unintended consequence: patients that need pain meds aren't getting them or are getting the wrong (no triplicate needed) med instead.

Labels: Misc

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: Misc

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

When I first went live with my practice on September 24th, 2007, I received plenty of criticism regarding patient privacy and security. Many people questioned my compliance with HIPAA, a federal law the vast majority of physicians and institutions in America have to abide by in order to protect patients’ private health information (PHI). PHI is defined as any situation where there is an identifying factor (such as name or SSN) associated with a diagnosis. For example, John Smith is telling me about his seasonal allergy symptoms via AIM. Under HIPAA, if I were IM’ing with a patient using an unsecure chat application, like AIM, I could face thousands of dollars in fines. If I revealed this health information with criminal intent, I could face up to $250,000 in fines and 10 years in prison.

If I signed contracts with insurance companies and/or Medicare and submitted online claims to these companies I would have to abide by HIPAA. My entire practice would be illegal. I could not email, IM, text, or video chat anyone using the ubiquitous most popular communication apps (like AIM, gmail, etc.) without breaking federal law. They are not encrypted and considered not secure. I would be fined out of existence and, if argued in court, I could even face years of jail time.

If any of you are wondering why your own doctor doesn’t communicate with you using email, IM, and other ways that simply make sense in today’s world, wonder no further. They break federal law with every email and IM since the vast majority of physicians have contracts with insurance companies or Medicare.

...Because I do not take health insurance, I am free from HIPAA regulations and therefore I can conveniently communicate with you in ways that simply and plainly just make sense in today’s world. People have criticized me, a solo physician who will likely have about 1,000 patients in my practice, about security and privacy (FYI...all of my patient medical records are encrypted, password protected twice on my laptop and backed up daily to a secure, encrypted remote server). Those who question me seem horribly concerned about my patients’ privacy. Meanwhile, those of you who do have health insurance with the major insurance companies, please beware. Your name, SSN, and medical information are stored along with hundreds of thousands, if not millions, of other people in enormous databases at your mega-insurance company. The people responsible for that CD they’re using to transport maybe 196,000 people’s PHI aren’t doing such a good job. I guarantee I won’t have to provide 12 months of free Equifax to you if you are my patient. Go with the big guys and kiss your privacy goodbye. I personally use Apple’s encryption technology called Firevault. According to Apple, it could take as long as 149 trillion years to crack my password using a computer that could attempt it every second.

Labels: Insurance, Misc

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Labels: Misc

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Can Capitalism Save American Health Care?

We are surrounded by medical miracles: polio has been eradicated; childhood leukemia is now treatable; death by cardiovascular disease has declined by two-thirds in the last fifty years. Yet while American medicine has never been better, angst over American health care has never been greater.

Why is American health care such a mess? In his path breaking book Dr. David Gratzer goes to the heart of the problem, showing that the crisis in American health care stems largely from its addiction to outmoded and discredited economic ideas.

What needs to be done? Dr. Gratzer mounts a bold and provocative argument, rejecting the conventional wisdom that socialized health care is compassionate. Instead, he prescribes a dose of capitalism.

Weighing in on the most controversial topics in health care, Dr. Gratzer makes the case that it's possible to reduce health expenses, insure millions more, and improve quality of care while not growing government or raising taxes. He is an award-wining author, essayist, and a master storyteller.

* Is a single-payer health care system really the panacea many people believe?

* We allow market mechanisms to organize five-sixths of the U.S. economy. Can markets work in the one-sixth represented by health care?

* Can we cast-off the yoke of employer-sponsored health plans and make health care truly portable?

* Can anything be done to avert the looming crises in Medicaid and Medicare?

Thursday, October 18, 2007
Kent Denver School, Anschutz Theatre
4000 East Quincy Avenue
Englewood, Colorado

Lecture:
Doors Open at 5:15 p.m.
Program Begins at 5:45
Lecture with Q & A, from 6:00 - 7:00 p.m.
Tickets, $20 per person

Patron Dinner:
7:00 - 9:00 p.m.
Tickets, $150 per person (includes lecture)

Directions: Kent Denver School is located at the intersection of Colorado Boulevard and Quincy Avenue in Englewood, Colorado.

About the Speaker

David Gratzer, a physician in Toronto, Canada, is a senior fellow at the Manhattan Institute and peer reviewer for numerous publications. Dr. Gratzer's research interests include Medicare and Medicaid, drug reimportation, and FDA reform. He is the author of the 2006 book The Cure: How Capitalism Can Save American Health Care. Dr. Gratzer is frequently invited to speak on health reform and is often quoted on health matters across North America. He has been cited in the New England Journal of Medicine, The Wall Street Journal, The Washington Post and The Los Angeles Times.

Labels: Analysis, Free Market, Misc

E-mail Paul Hsieh, MD / PermaLink / Comments / Trackbacks / BlogThis

Let's see: When the GOP was in charge of the Senate and the Oval Office, it passed COBRA and EMTALA, two major expansions of government regulation into health care. When the GOP controlled both house of Congress, it passed HIPAA, another big expansion of government regulation into health care, plus a new government health insurance program, the State Children's Health Insurance Program (SCHIP). Now, Republicans like Orrin Hatch and Chuck Grassley are leading the charge for a big SCHIP expansion. Finally, Republican Senator Pete Domenici is pushing for a nationwide "mental health parity" benefit mandate, one that President Bush says he will sign if it passes.

"Most" Republicans believe in believe in expanding individual choice? Heck, I'd settle for half.

Labels: Misc

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